Tag: disorder

Popular Psychology, The Perplexed Minds of Teenagers

Disordered Eating And Body Image Issues In Teenage Girls: Part 1

by Torey C. Richards, LMHC2 Comments on Disordered Eating And Body Image Issues In Teenage Girls: Part 1

6a00d8341bf67c53ef014e8c0ffaab970d-800wi (1)Working in a high school with teenage girls, I come across teenage girls with body image issues regularly.

Take for instance, one of my 15 year old clients who is so convinced that she is fat that when I first met her she was only drinking water mixed with apple cider vinegar for breakfast and lunch.

For dinner she would have a very small meal. She was not overweight, but due to teasing about her “putting on some weight” by both her mom and peers, she see’s herself as fat and ugly.

Because of all this, her self-esteem is shot and it’s taken weekly individual therapy sessions and weekly support group sessions to get her to at least start eating a light breakfast and lunch, although she is still struggling with body image and self-esteem issues.

Society Creates Body Image Issues In Girls

Unlike boys, teenage girls are put under immense pressure to be beautiful, thin and feminine in most Western industrialized countries. However, biological changes and weight gain are natural parts of pubertal development.

Like the client I was talking about above, her weight gain seems to be more of a womanly weight gain. She seems to be filling out and taken on the body of a woman, compared to that of a prepubescent child. This natural weight gain that most girls experience during puberty, goes against our cultural’s  view of what being beautiful is, which for women includes extreme thinness.

These are conflicting messages for preteen and teenage girls.

On one hand, they are naturally developing and putting on weight, while on the other hand, they are getting messages from society that says their weight gain is unattractive.

Female identity in one part is defined in relational terms, society says they are supposed to be interpersonal and care about other peoples needs, feelings and interests which makes them more vulnerable than males to other people’s behaviors towards and opinions of them.

Another major part of female identity is beauty. In our culture, physical attractiveness contributes a lot to interpersonal success, which is one of the main reasons females strive to be beautiful, to assure popularity and respect.

Also, physically attractive girls are typically seen as more feminine compared to less attractive girls or girls who challenge our cultures traditional views on femininity through their political views such as feminist, or through their sexual orientation, such as lesbians.

Girls tell our society that they are feminine by being concerned with her looks and trying to achieve our culture’s ideal of beauty.

Because our culture demands that girls care about other people’s opinions and that they are defined by their physical appearance,  which society says includes being very thin, there’s no wonder girls are motivated to pursue thinness, at times by any means necessary including starving themselves to death.

Combine these issues with the natural weight gain of puberty and there’s no wonder many teenage girls develop body image issues.

Many teenage girls I’ve worked with who are physically perfect, not even slightly overweight, some were even underweight,  suffer from intense body image dissatisfaction.

A girl I’ve been working with since last year was naturally thin, yet wanted to be thinner so bad that she starved herself to the point of needing to be hospitalized. Like many of the girls I work with who have body image issues, her pursuit for thinness and beauty was so consuming that almost every other aspect of her life, including her education, goals and future took a back seat.

Eating Disorders

Not all girls with body image issues go on to develop an eating disorder like the young girl I just mentioned above, but many of them will.

Eating disorders are a major concern when it comes to the health of teenage girls with an estimated 1% to 3% likely to meet diagnostic criteria for either anorexia nervosa or bulimia nervosa.

Anorexia nervosa is when someone refuses to maintain a minimal average body weight and has body image disturbances such as feeling fat even when they are very thin, and in females who are menstruating, they may experience amenorrhea if their body weight is low enough.

Bulimia nervosa typically includes periods of binge eating, followed by drastic methods to compensate for the binge eating including excessive exercising, fasting, vomiting, using laxatives, etc., accompanied with body image disturbance such as thinking one is much more overweight or unattractive than they really are.

Besides these two eating disorders, there are some girls who have other patterns of eating that fall under disordered eating, such as laxative abuse, vomiting after eating some meals, extreme calorie restriction, and binge eating.

Eating disorders typically begin in early adolescence with much of it’s symptoms typically evident by the late teen years.

While not all girls with body image issues develop full blown eating disorders, there is little research into why some girls do and others don’t develop an eating disorder.

During part 2 we will look at some of the risk and protective factors for young girls to develop an eating disorder.

Popular Psychology

Presidential Election Stress Disorder

by Torey C. Richards, LMHC1 Comment on Presidential Election Stress Disorder

The morning after the first presidential debate between President Barack Obama and Governor Mitt Romney, I got a long text message from a very good friend saying that she was extremely stressed about the debate and all the negative things being said in the press about President Obama’s performance.

This friend asked me to give her some encouraging, professional advice. I was a little stunned because I have never had anyone tell me that they were so stressed out about an election that they wanted professional advice to help relax.

Soon afterwards I had an older woman tell me that she couldn’t sleep the night after the debate because she was so stressed and she also watched the cable news channels incessantly.

This got me to start paying more attention to presidential election stress and noticed it was all around me.

At work, coworkers vented about their frustration either with the President or with Mitt Romney. At the barbershop, the car wash, at the grocery store… everywhere I went I seemed to over hear people stressing in one form or another about the upcoming election.

Some people are engrossed in the election almost every waken hour. They are glued to CNN, MSNBC, FOX, or whatever channel. When they aren’t watching television they are online either reading articles or engaged in back and forth bickering in cyberspace.

Even when they aren’t doing those things they are either talking about the election, or spending too much time thinking about it.

If this seems a little obsessive, that’s where presidential election stress goes from normal to presidential election stress disorder.

Even my mother told me that she was stressed about the election and of course her television seems to be stuck on the cable news channels as well. She’s had trouble sleeping because she is worried about the upcoming election and talks about it endlessly to whom ever will listen to her so I gave her the same advice I gave my friend.

1. Disconnect– sometimes we have to turn off the television and get off the internet where we are too easily bombarded by campaign ads, political arguing or other things that can trigger our presidential election stress.

This includes Facebook, Twitter and other social sites where it’s easy to get pulled into political debates. At the least, watch something funny, silly, or interesting that has nothing to do with the election, and the same goes for websites.

2. Get out of the house– exercise, go for a mindfulness walk and appreciate the moment of now. Look at flowers, breath in the air, close your eyes and listen to what’s around you, shutting out all other thoughts about the past or the future, only the present.

3. Focus on you- get back to doing things you enjoy doing such as reading, writing, drawing, knitting, whatever it is you enjoy doing that can take your mind off of the election.

This upcoming presidential election is extremely important, I agree. It makes since that so many people are personally vested in their party or candidate of choice. It’s okay to be passionate, but it’s not okay to be angry, stressed, or depressed over the election and if you are, it’s time to take care of your self and take a break.

Abnormal Psychology

On Childhood Disintegrative Disorder

by Torey C. Richards, LMHCLeave a Comment on On Childhood Disintegrative Disorder


We conclude our discussion on the Pervasive Developmental Disorders with a brief overview of Childhood Disintegrative Disorder.

Introduction

Childhood Disintegrative Disorder (CDD), is also known as Heller’s Syndrome and Disintegrative Pschosis.  It is a rare Pervasive Developmental Disorder that affects about 1 in 100,000 children. CDD resembles many of the other disorders on the Autism spectrum in the fact that it involves developmental delays, impairment in communication and social functioning, but most closely resembles Rett syndrome in that it almost exclusively affects boys whereas Rett syndrome almost exclusively affects girls. New research suggest that while CDD affects boys more than girls at a rate of 4 to 1, it is thought that girls diagnosed with CDD most likely should have been diagnosed with Rett. There is also further talk that in the future Rett and possibly even CDD won’t be separate diagnosis, but that they will both be collapsed into the Autistic category as low functioning forms of Autism.

Symptoms

Children with CDD develop normally up until about ages 2 to 4 years of age (rarely there are cases of delayed onset up to 10 years of age), and then start regressing, losing previously acquired developmental skills with in a few months to years, including language, non-verbal communication skills, motor skills and social skills.

Symptoms include:

    • Delay or lack of spoken language
    • Impairment in nonverbal behaviors
    • Inability to start or maintain a conversation
    • Lack of play
    • Loss of bowel and bladder control
    • Loss of language or communication skills
    • Loss of motor skills
    • Loss of social skills
    • Problems forming relationships with other children and family members

Causes

There are no known causes of CDD although abnormal electroencephalograms (EEG), epilepsy, Lipid storage diseases (excess build up of toxic fats in the brain and nervous system), Tuberous sclerosis (benign tumors that may grow in the brain and other vital organs) and Subacute sclerosing panencephalitis (chronic infection of the brain due to a form of the measles that damage the brain) all appear to be associated with CDD.

Treatment

There is no cure for Childhood Disintegrative Disorder and the treatment for it is similar to the treatment for all of the Pervasive Developmental Disorders with the addition of trials with steroid medications to try to slow down the progress of the disorder.

Diagnosis

Physicians will use some of the same assessment tools used to diagnose the other Pervasive Developmental disorders with the inclusion of all the symptoms listed above and impairment in normal function or impairment in at least two of the following three areas:

  • Social interaction
  • Communication
  • Repetitive behavior & interest patterns

The main symptoms to look for in diagnosing CDD is the loss of previous learned skills in at least two of these areas:

  • Expressive language skills (being able to produce speech and communicate a message)
  • Receptive language skills (comprehension of language – listening and understanding what is communicated)
  • Social skills & self-care skills
  • Control over bowel and bladder
  • Play skills
  • Motor skills

If your child has any developmental delays or starts to lose developmental functions previously learned, it is vital to talk with your physician in order to rule out  CDD or any of the Pervasive Developmental Disorders or mental retardation. The faster any illness is discovered and treatment begins, even if there is no cure, the better the prognosis or at least the slowing of the progress of the disorder. Some children with similar, yet less severe symptoms may have a learning disability or something much less serious than a Pervasive Developmental Disorder, but it is important to have everything ruled out for the best care of your child.

Abnormal Psychology, Uncategorized

On Rett Syndrome

by Torey C. Richards, LMHCLeave a Comment on On Rett Syndrome

An Introduction to Rett Syndrome

 What separates Rett syndrome from the other Pervasive Developmental Disorders is that it almost exclusively affects girls, whereas Autistic Disorder affects boys at a much higher rate than girls.

Worldwide Rett Syndrome affects 1 in every 10,000 to 15,000 females of all races and ethnicity. Prenatal testing is possible for families who have had a child born with Rett, but since the chances of developing Rett is so low, the chances of a family having two children born with Rett is less than 1%. Most boys born with the genes thought to be responsible for Rett often die shortly after birth. Because Rett syndrome is thought to be caused by a mutation to the X chromosome, girls are thought to be more able to compensate for the mutation because they have two X chromosomes where boys only have one and aren’t able to compensate.

In Rett Syndrome, similar to Asperger’s, there is normal early development and then a slowing of development, distinctive hand movements, lack of purposeful use of hands, and slowed head and brain growth. Problems walking, seizures and intellectual disability are usually also present. This disorder was first described by Dr. Andreas Rett, an Austrian physician in 1966, but it wasn’t until later in 1983 that it was recognized as a disorder after an article about it was written by Swedish researcher Dr. Bengt Hagbeg.

Like all of the Pervasive Developmental Disorders, the severity of symptoms in Rett varies from child to child, but they all start with relatively normal development, although loss of muscle tone (hypotonia), jerkiness in limb movements and difficulty feeding are often noticeable even in infancy. Gradually more apparent physical and mental symptoms become apparent such as the inability to talk and loss of purposefully movement of hands which is followed by compulsive hand movements such as wringing and washing.  Other symptoms such as problems walking, crawling and lack of eye contact may also be early signs. This period of regression is often sudden. The inability to perform motor functions (Apraxia) is one of the most severe disabilities of Rett syndrome, it effects body movement, eye gaze and speech.

Early stages of Rett syndrome often resemble Autistic disorder or one of the other Pervasive Developmental Disorders.  Some symptoms may also include walking on toes, awkward gait, difficulty chewing, teeth grinding, slowed growth, sleep problems, breathing problems, air swallowing, cognitive disabilities and apnea (holding breath)..

Diagnosis

Rett is typically diagnosed by a developmental pediatrician, pediatric neurologist or clinical neurologist using many of the same neurological, physical and psychological assessments used to diagnose the other Pervasive Developmental Disorders with the inclusion of genetic testing to look for the MECP2 mutation on the child’s X chromosome.

The Diagnostic and Statistical Manual of Mental Disorders also has these criteria for diagnosing Rett Disorder.

  • All of the following:
    • apparently normal prenatal and perinatal development
    • apparently normal psychomotor development through the first 5 months after birth
    • normal head circumference at birth
  • Onset of all of the following after the period of normal development:
    • deceleration of head growth between ages 5 and 48 months
    • loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (i.e., hand-wringing or hand washing)
    • loss of social engagement early in the course (although often social interaction develops later)
    • appearance of poorly coordinated gait or trunk movements
    • severely impaired expressive and receptive language development with severe psychomotor retardation

Causes

According to research, nearly all cases of Rett syndrome are due to a mutation in the metyl CpG binding protein 2 (MECP2) gene. The gene was discovered in 1999 and controls many other genes. It may also be responsible for some of the other Pervasive Developmental Disorders. This gene is needed for brain development and helps other genes increase or decrease their own unique expressions and proteins. This genes malfunction causes other genes to become abnormal. The puzzling thing is, not everyone with MECP2 mutation has Rett syndrome, so other genetic mutations are also thought to be responsible and research is ongoing. Rett syndrome is not thought to be genetic. Only about 1% of Rett syndrome cases are thought to be inherited, which means that in the overwhelming majority of cases, the gene mutations are random.

Treatment

Just like all the other Pervasive Developmental Disorders, there is no cure for Rett Syndrome and treatment is pretty similar including medication and therapy to help control and minimize many of the disabling features of Rett syndrome.

Although Rett syndrome can be very disabling, many people with Rett live to be in their 40’s and 50’s and perhaps even longer . 

Resources

International Rett Syndrome Foundation: www.rettsyndrome.org

National Institute of Child Health and Human Development (NICHD): www.nichd.nih.gov

Office of Rare Diseases: www.rarediseases.info.nih.gov

Rett Syndrome Research Trust: www.rsrt.org

Abnormal Psychology, Popular Psychology

On Asperger’s Disorder

by Torey C. Richards, LMHCLeave a Comment on On Asperger’s Disorder

In the 1940s, a pediatrician working in a clinic in Vienna named Hans Asperger treated several patients who displayed similar symptoms. However, because his work was conducted during World War II, none of it was seen amongst the English-speaking world so it wasn’t until the 1980s that his work was discovered by the English-speaking community and was translated in 1991 by Uta Frith. The characteristic first described by Hans Asperger became known as Asperger’s Disorder.

What Is Asperger’s Disorder?

Just like all of the Pervasive Developmental Disorders, children with Asperger’s have trouble relating to others.  In some children this means that they do not like interacting with others, or that they do enjoy interacting with others but lack the non-verbal skills (i.e. eye contact, smiling, facial expression, touching) necessary to have full interaction. Having a two way conversation with a child with Asperger’s is often very difficult because they have trouble understanding figures of speech, sarcasm, subtle suggestions and often take speech very literally.  These children are also often unaware of their own behavior and can’t relate to other children at their developmental level.

Children with Asperger’s also often have unusual behaviors and interests. Some children become almost obsessed with an object or ideal to the point that they exclude everything else. For example, a young man I worked with was very interested in sports and would talk you to death about sports, but only sports and if you tried to talk to him about anything unrelated to sports he would just go back to talking about sports. In other children, they may have extreme reactions to simple changes to their environment (i.e. movement of furniture or objects) or routine.

While all children with Asperger’s have impairment in social and behavior functions, the degree of impairment differs in each child. To be diagnosed with Asperger’s the symptoms have to be severe enough that it impacts their life (i.e. school functioning, family function, or social life).

How Does Asperger’s Differ from Autistic Disorder?

Asperger’s differs from Autistic Disorder in that there are no significant delays in cognition or language development.  Many children with Asperger’s have difficulty with non-verbal communication, hand eye-coordination and may appear clumsy. Some children with Asperger’s have an exceptional vocabulary and may speak earlier than expected. Because children with Asperger’s appear to develop normally, they usually aren’t diagnosed before the age of five while children with Autistic Disorder are generally diagnosed earlier. Some people reach all the way to adulthood without being diagnosed with Asperger’s, whereas children with Autistic Disorder generally aren’t expected to live independently.

Risk for Other Issues

Children with Asperger’s Disorder are often also diagnosed with Attention Deficit/Hyperactivity Disorder. They are also at a higher risk for Obsessive-Compulsive disorder. Undiagnosed children with Asperger’s often experience depression and social isolation, especially in their adolescent years when peer interactions and relationships become more important.

Diagnostic Criteria (Diagnostic and Statistical Manual of Mental Disorders IV)

I) Qualitative impairment in social interaction, as manifested by at least two of the following:

(A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
(B) failure to develop peer relationships appropriate to developmental level
(C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)
(D) lack of social or emotional reciprocity

(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:

(A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(B) apparently inflexible adherence to specific, nonfunctional routines or rituals
(C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
(D) persistent preoccupation with parts of objects
(III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.

(IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)

(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.

(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.”

I Think My Child May Have Asperger’s Disorder, What Do I Do?

If you think your child has symptoms of Asperger’s Disorder, contact your physician, school psychologist or a licensed psychologist to initiate an evaluation. Thorough medical, family and developmental histories will be taken, as well as interviews with the family and child as well as behavioral observations to help determine if a diagnosis of Asperger’s Disorder is correct.

All of the interventions and prognosis for Asperger’s Disorder are basically the same for all the other Pervasive Developmental Disorders and you can find those on my post about Pervasive Developmental Disorders.

Resources

Attwood, Tony. (2006) The Complete Guide to Asperger’s Syndrome. Jessica Kingsley Publishers.

Online Asperger Syndrome Information and Support

(OASIS) http://udel.edu/bkirby/asperger/

Center for Autism and Related Disabilities (CARD): http://card.ufl.edu/

Abnormal Psychology, Popular Psychology, Uncategorized

On Autistic Disorder

by Torey C. Richards, LMHCLeave a Comment on On Autistic Disorder

In my years in the field of mental health, I’ve had the privilege to work briefly with children who had Autistic Disorder. That brief time gave me a tremendous amount of respect for these children, those who work with them regularly as well as the parents who care for them around the clock. The degree of impairment in each child was sometimes drastically different. Some didn’t move from the same spot all day, staring out into space and rocking back and forth while others were very mobile and verbal (even if I couldn’t understand a word they were saying). Most of them were very rigid however in appearance, behavior and psychomotor activity.

If you haven’t done so already, you may want to read the post I wrote on Pervasive Developmental Disorders in order to get a better understanding of Autistic Disorder and all of the other Pervasive Developmental Disorders under the Autism Spectrum.

Autistic Disorder shares a lot in common with all the previously discussed Pervasive Developmental Disorders and is sometimes referred to as early infantile autism or childhood autism. To add to the confusion of labeling, some professionals use Autistic Disorder to describe all five of the pervasive developmental disorders (Autistic Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s disorder, Pervasive Developmental Disorder Not Otherwise Specified) under the Autistic spectrum.

Brief Introduction to Autistic Disorder

Autistic Disorder is four times more common in boys than in girls. Children with Autistic Disorder have a moderate to severe range of communication, behavior problems and socialization abilities. Many of them also have mental retardation. It is also thought to be high genetic.

Like all of the other Pervasive Developmental Disorders, parents of children with Autistic Disorder normally notice signs within the first two to three years of life. They usually develop gradually, but sometimes the child will develop normally at first and then regress.

Early behavioral and cognitive interventions are essential in helping children with Autistic Disorder learn to improve their skills of self-care, communication and socialization. Most children with the disorder will never live independently as adults and while there is no cure, they have been reported cases of children who have appeared to recover from it.

Diagnostic Criteria for Autistic Disorder

The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) uses these criteria to aid in the diagnosis of Autistic Disorder.

  1. Six or more items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3):
      1. qualitative impairment in social interaction, as manifested by at least two of the following:
        1. marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
        2. failure to develop peer relationships appropriate to developmental level
        3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
        4. lack of social or emotional reciprocity
    1. qualitative impairments in communication as manifested by at least one of the following:
      1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
      2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
      3. stereotyped and repetitive use of language or idiosyncratic language
      4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
    1. restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
      1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
      2. apparently inflexible adherence to specific, nonfunctional routines or rituals
      3. stereotyped and repetitive motor manners (e.g., hand or finger flapping or twisting, or complex whole-body movements)
      4. persistent preoccupation with parts of objects
  4. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play.
  5. The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

For more information visit http://www.autismspeaks.org

Abnormal Psychology, Uncategorized

Pervasive Developmental Disorders

by Torey C. Richards, LMHCLeave a Comment on Pervasive Developmental Disorders

Pervasive Developmental Disorders (PDD) are also known as Autistic Spectrum Disorders. They include a group of five neurological disorders characterized by developmental delays of basic functions such as the ability to communicate, understand language, and socialize with others including peers and family. The five developmental disorders are:

  • Autistic Disorder
  • Rett’s Disorder
  • Childhood Disintegrative Disorder
  • Asperger’s Disorder
  • Pervasive Developmental Disorders Not Otherwise Specified

Many parents are often confused by the term Pervasive Developmental Disorders when their child is diagnosed. Often this is because a lot of doctors are hesitant to diagnose very young children with a specific PDD, but PDD is not a true diagnosis, but a category that includes all five of the disorders listed above. The official diagnosis in this case should be Pervasive Developmental Disorders Not Otherwise Specified (PDDNOS) which simple means that there is a pervasive developmental disorder present, but the doctor has yet to narrow down which exact disorder it is.

I could write a very long post that tried to cover all of the PDDs, but that would be very long and perhaps confusing, so what I am going to do is post one at a time over the next few days. To understand each PDD it is good to have a definition of the overall disorder and so we will start with PDDNOS.

Pervasive Developmental Disorders Not Otherwise Specified

All PDDs are neurological disorders that are usually evident by the time the child is three years old. They generally have trouble playing with their peers, socializing and relating to others. They also often have stereotyped behavior, interest and activities, inappropriate fascination with objects and often don’t like changes, even small ones. One parent vented her frustration to me saying that it felt like her child was always rejecting her.

Children with PDDNOS either do not fully meet the criteria of the other PDDs or do not have the degree of impairment usually considered suitable to fulfill the diagnosis of the other four disorders. According to the Diagnosis and Statistical Manual of Mental Disorders IV (DSM-IV), this diagnosis should be used “when there is a severe and pervasive impairment in the development of social interaction or verbal and nonverbal communication skills, or when stereotyped behavior, interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder” (American Psychiatric Association).

In general, children are usually diagnosed with PDDNOS when they have behaviors that are seen in Autism, but doesn’t meet the full diagnostic criteria.

Part of the confusion with PDDs is that the DSM-IV should be used as a guideline for diagnosing PDDS. Many doctors use it as a checklist. There are no clear guidelines for measure severity of symptoms which cause the lines between Autism and PDDNOS to become blurred. Confusion is also added in the fact that some doctors feel that Autistic Disorder only covers those who show extreme symptoms that meet every single criteria for it, while other doctors are comfortable using Autistic Disorder to define those with a broad range of symptoms related to language and social skills. Therefore, it is not uncommon for an individual to be diagnosed by one doctor as having Autistic Disorder and by another as having PDDNOS. There is growing evidence that PDDNOS and Autistic Disorder aren’t actually separate disorders, but are on a continuum which is why the term Autistic Spectrum Disorders is now frequently used to refer to PDDs. Multisystem Developmental Disorders is another term thrown around seldomly, but it is the same as PDDNOS and Autistic Spectrum Disorder.

Causes of PDDNOS

Studies that include behavioral and biological studies all suggest that PDDNOS is caused by neurological abnormalities (problems with the nervous system). However, no specific cause is known. There’s been controversy about childhood vaccinations being responsible for PDDNOS, but no clear evidence or studies have been able to show consistent evidence supporting that.

Symptoms/Signs of PDDNOS

These are some of the symptoms and signs of PDDNOS. Since it is a spectrum disorder, not all children will show the same symptoms, all of the symptoms or have the same intensity of symptoms as other children with PDDNOS.

  • Impairment in Nonverbal Communication
  • Impairment in Understanding Speech
  • Impairment in Speech Development
  • Abnormal Attachments and Behaviors
  • Unusual Responses to Sensory Experiences
  • Disturbance of Movement
  • Resistance to Change
  • Intellectual and Cognitive Deficits

They may also have associated features such as emotional expressions that are flat, excessive or inappropriate to the situation. They may scream, cry or laugh at any time for no apparent reason. They may not be afraid of real dangers such as falling or getting hit by a car, yet be terrified by a specific doll or stuffed animal.

Diagnosis

The DSM-IV is only one tool used to help diagnose PDDNOS. Medical assessments, occupational assessments (used to determine how the child’s different senses work together), interviews with the child’s parents, teachers, behavioral rating scales, psychological assessments, educational assessments and direct behavioral observations are some of the many other tools used to help diagnose PDDNOS. There are no specific test such as blood tests, or x-ray exams that can determine if a child has PDDNOS or not.

Treatments

Treatments for PDDNOS are usually the same used to treat all PDDs, but no one treatment will help all children and often they need to be individualized. Common treatments include:

  • behavior modification
  • structured educational approaches
  • medications
  • speech therapy
  • occupational therapy
  • counseling
  • family counseling
  • psychological treatment
  • facilitated communication
  • Auditory Integrative Therapy
  • Sensory Integrative Therapy
  • Dietary Therapies
The aim is typically to promote more acceptable and appropriate social and communication behavior as well as to minimize negative behaviors such as repetitive behaviors, self-injury, hyperactivity and aggression.

It is also important for parents of children with PDDNOS or any PDD (just like parents of children with any other disorder) to seek out help in the form of parent support groups in order to educate, remember that they are not alone and also to replenish themselves.

I hope that this post on PDDNOS was helpful. I realized halfway through writing this how tough it was going to be to try to cover PDDNOS in one post, partway through I was like, “What was I thinking” but hopefully I’ve laid out a decent basis to start discussing the other four disorders starting with Autistic Disorder tomorrow.

For those of you who want more information I’ve included the names, contact information and web addresses of some organizations below.

Resources

Autism Coalition
http://www.autismcoalition.com

Autism Patient Center
http://www.patientcenters.com/autism


Autism-PDD Resources Network
http://www.autism-pdd.net


Division TEACCH: http://www.teacch.com


Indiana Resource Center for Autism
http://www.iidc.indiana.edu/irca


National Institute of Child Health and
Human Development
http://www.nichd.nih.gov/publications/
pubskey.cfm

Asperger Syndrome Coalition of the United States, Inc. (ASCU.S.)
2020 Pennsylvania Ave., NW, Box 771, Washington, DC 20006
Telephone: 1-866-427-7747
Web: http://www.asperger.org
 
Autism Society of America
7910 Woodmont Avenue, Suite 300
Bethesda, MD 20814
Telephone: 1-800-328-8476
Web: http://www.autismsociety.org

International Rett Syndrome
Association, 9121 Piscataway Road,
Clinton, MD 20735. Telephone:
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The Perplexed Minds of Teenagers

Is Pretending to be Pregnant a Mental Illness?

by Torey C. Richards, LMHC165 Comments on Is Pretending to be Pregnant a Mental Illness?

In The Pregnancy Project: A Memoir, Gaby Rodriguez faked her own pregnancy as a social experiment, but teenage girls pretending to be pregnant is not a new phenomenon.

Over the past three years I’ve grown more and more concerned about teenage girls pretending to be pregnant, the reasons they do this and the mental and social rewards and consequences of it. I have to wonder if part of this is because of shows like 16 and Pregnant and Teen Mom, but I also think that the alarming number of their peers who actually are pregnant or have kids has an effect on them. Why would a teenage girl want to put up with the scrutiny and criticism that comes along with being pregnant in high school? This is what I think:

1. Attention

  • Some of these young girls are starving for attention no matter if it’s positive or negative. Perhaps they see all the attention their peers or siblings got when they were pregnant and crave some of that same attention. I often see that their friends, while at times judgmental, often start bonding with the young girl in a nurturing way, something that she doesn’t get normally from them.

2. To Keep a Boy Interested

  • I think this may be the most common reason young girls pretend to be pregnant. I see it played out over and over again each year in the high school I work at. A relationship ends or is on the break of ending and all of a sudden the young girl blurts out she’s pregnant or thinks she’s pregnant. This usually sends the young man into a panic and even if he’s skeptical, he tends to at least try to stay on her good side until the pregnancy is confirmed or denied. Like a lot of young teens who pretend to be pregnant, these ladies may go through great lengths to convince their boyfriends (ex-boyfriend) that they are pregnant and often times in the process, continue to try to really get pregnant. These drastic attempts to keep a boy are seldom successful.

3. Biology

  • Evolutional psychology may say that it is normal for young teens to pretend to be pregnant since it’s in their biology to want to conceive children. During my research it appears that pretending to be pregnant is to some extend normal, but I think what is abnormal is the way that some young adults go about pretending to be pregnant. Perhaps pretending to be pregnant to yourself is normal, while pretending to be pregnant and in effect lying to your friends/boyfriend is more on the abnormal end of the scale. However, if it is to some extend normal to pretend to be pregnant, can it ever go so far that it can be classified as a mental illness. To what extent does a young girl have to go to inorder convince people she is pregnant, before she moves into the realm of psychopathology?

More recently, Annette Morales Rodriguez was arrested and suspected of stalking, beating and choking to death a pregnant woman and using an xacto knife to remove her unborn child because she had had four miscarriages and had been faking her pregnancy.

One source said that she panicked as her fake due date approached and she had to produce a baby. She was willing to kill in order to “have” a child.

Pretending to be Pregnant as a Mental Illness

I have a client I’ve known for three years and each year she “gets pregnant”. I was originally referred to her when she “gave birth” to a premature baby and was back at school the next day showing pictures of “this baby” in neo-intensive care. One of her teachers was concerned about her physical and mental health and referred her to me. When I met with her she told me that the baby had died and I spend several weeks helping her get through the grieving process and even helped her with a memorial ceremony. A few months later I found out that this was all a lie. She was never pregnant. The pictures of the baby in NIC-U had come from Google Images, and this wasn’t the first time she had pretended to be pregnant. The extend to which this young girl went through to convince people she was pregnant and had given birth to a premature baby that died concerned me. I thought surely she was mentally ill, but I let it go as the next year her problems turned to the more normal problems teenage girls come and see me about (boys, family, school, friends, drugs).

And then this year she said she was pregnant again. This time I believed her (call me gullible, but I tend to believe people until I have evidence not to) because from her pretending to be pregnant last year, I felt like she wanted to get pregnant, and from my experience, young girls that talk a lot about being pregnant, pretend to be pregnant, and are sexually active, they usually end up pregnant within twelve months. Well this young girl started to gain weight, starting looking pregnant (even wore too small clothing to enhance the effect) up to a certain extend when she suddenly stopped “growing”. She claimed to feel the baby moving and said she went to doctor appointments, but would never let her friends go with her. She told her boyfriend she was pregnant and all of her friends, but not her family. She even went as far as to have her friends plan a baby shower. I offered over and over to help her break the news to her mom, but she refused and then one day her best friend came to my office in tears, telling me that she thinks the young girl is “crazy” because she really isn’t pregnant and keeps pretending to be pregnant. Her best friend told me that all of her friends and even her boyfriend are concerned for her, but they haven’t confronted her out of fear that she really is mentally ill.

After an intense session with the young girl she admitted to me that she really wasn’t pregnant, but couldn’t tell me why she kept pretending to be pregnant and was still planning on letting her friends and boyfriend think she was pregnant. As of Friday she was still planning her baby shower. That lead me to truly believe that this girl has a mental illness, but if so, what?

Factitious Disorders

The first thing that came to my mind was that she had a factitious disorder. Factitious disorders occur when a person acts like they have an illness and purposely produces symptoms of that illness. They may go as far as contaminating urine samples, manipulating documents and taking substances to make themselves ill. The benefits they seek usually are attention, sympathy, nurturance and mercy. The old term for factitious disorder is Munchausen Syndrome, and many of you have probably heard of Munchausen by proxy, which is when the person uses someone else, usually a child or elderly person, to produce the sick symptoms of an illness unto, often times with alarming and deadly results. But does a young girl who continues to pretend to be pregnant and goes to great lengths to convince people she is pregnant suffering from a factitious disorder? Through all my research I couldn’t find a definite answer, but this as of right now is my number one guess.

Personality Disorders

Borderline Personality Disorder

I also have to wonder if this girl and others like her may have some type of personality disorder. Borderline personality disorder is very popular these days, but I have only known about three people I would diagnose with borderline personality disorder and only  one of them have pretended to be pregnant in a very similar manner to the young girl I’ve been talking about. I also don’t think this young girl qualifies to be diagnosed with borderline personality disorder, but it is possible.

Histrionic Personality Disorder

People with histrionic personality disorder are always seeking attention and can be very inappropriately seductive, have exaggerated emotions and feel shallow. I’m not sure if this describes the young lady I’m talking about either.

Dependent Personality Disorder

People who have dependent personality disorder are dependent psychologically on other people. Pretending to be pregnant would increase the likelihood that the people this person is dependent on will be more nurturing and present, but from knowing this girl I highly doubt she has dependent personality disorder, but it may explain why some other young ladies pretend to be pregnant.

Psychopathy

Some people are just psychopaths as defined by:

  • lack of remorse or empathy
  • shallow emotions
  • manipulativeness
  • lying
  • egocentricity
  • glibness
  • low frustration tolerance
  • episodic relationships
  • parasitic lifestyle
  • persistent violation of social norms

Is it necessary that I diagnose this young lady and those like her? Probably not. I prefer not to diagnose clients unless I have to or it is a diagnoses that is literally screaming in my face. I don’t like labeling clients, but there are many reasons to give a diagnosis. Most insurance companies require a diagnosis and a diagnosis does help give a framework for developing a treatment plan. It is however, in my opinion, essential that I figure out what is driving this young girl and others like her to go through such great extents to pretend to be pregnant in hopes of helping them deal with whatever it is they are trying to get externally, and be able to give it to themselves so that they can develop into emotionally and mentally healthy adults.

If you have any opinions or if you’ve been through this or even pretended to be pregnant before, please comment. I would love to hear your story.

Abnormal Psychology, Popular Psychology

Bipolar Disorder in Children and Adolescents

by Torey C. Richards, LMHC3 Comments on Bipolar Disorder in Children and Adolescents

Often times bipolar disorder is thought of as an illness that effects mostly young adults, and while the average age of bipolar disorder is around the age of 21, younger children and teens can also be effected with the disorder, sometimes referred to as pediatric bipolar disorder.

Working in a high school with students who mostly have anger problems, I hear a lot of them talking about their “mood swings” and some of them even call themselves “bipolar” although they have never been officially diagnosed. But almost everyone has mood swings from time to time, so what exactly is bipolar disorder?

Bipolar Disorder

Bipolar disorder (sometimes called manic-depressive disorder) is a brain illness characterized by episodes of intense mood swings and behaviors known as mania (high energy, elated, impulsive, etc.) and depression that are usually high or low and shift, generally over days or weeks, and sometimes even blend (mixed episodes). It is not the same as the normal ups and down adolescents and teens go through, it is much more severe.

Early onset bipolar disorder happens in adolescence and the early teenage years and may be more severe than bipolar that develops later in life. There was a time in the past when most experts did not believe that bipolar disorder could happen in childhood, but research shows that at least half of bipolar disorder cases start before the age of 25. Children with bipolar disorder often have co-occurring disorders such as attention deficit-hyperactivity disorder and anxiety disorders.

Symptoms

Adolescents and teens exhibiting a manic episode of bipolar disorder may:

  • Feel very happy and act silly in a way that is unusal
  • Talk really fast about a lot of different things
  • Have a short temper
  • Do risky things (i.e. jumping off of things, dashing in front of cars)
  • Have trouble sleeping, yet not feel tired
  • Have trouble staying focused
  • Talk and think about sex more often (if they are sexually active they may actively seek out sexual encounters)
Adolescents and teens exhibiting a depressive episode of bipolar disorder may:
  • Sleep too little or too much
  • Be very sad/depressed
  • Complain about various pains such as stomach and headaches
  • Eat too little or too much
  • Feel very guilty
  • Be overly emotional and/or sensitive
  • Have little energy or interest in doing anything
  • Think/talk about suicide and/or death

Treatments

Treatments for bipolar disorder include medications and psychotherapies including family therapy (it is important that parents taking care of a child with bipolar disorder, just like any other illness, take the time for self-care in order to be healthy and effective caregivers themselves). There is a concern that many children are being over diagnosed with bipolar disorder since in children, bipolar disorder can also look like other disorders such as severe mood dysregulation or temper dysregulation disorder, and some children may not have a disorder at all but be expressing another, normal biopsychological response to life stressors. While there is no way to prevent bipolar disorder, there is ongoing research trying to find a way to delay the onset of symptoms in children with a family history of the disorder.

I currently see 69 adolescents and adults for various reasons and only about three or four I would seriously evaluate for bipoloar disorder and two I have diagnosed with it. One of them is a 15 year old female and her parents are currently in denial of the seriousness of her illness, yet don’t understand why she isn’t getting better although I’ve had to Baker Act (Florida’s statue for involuntary examination of an individual where they are kept up to 72hrs in a hospital for their saftey) due to suicidal thoughts and self-injury. I’ve also referred them repeatedly for medication evaluations, but again, her parents are in denial and think her issue is all behavioral and not a real illness like bipolar disorder. I have another 15 year old girl I diagnosed with bipolar disorder and she is now on medication (Trilecta) and seeing me for cognitive behavioral therapy and is doing a lot better.

Where to go for Help?

As always, your family doctor or mental health professional should be able to direct you to the proper source of help for your child. If not, look up a doctor or mental health facility in your area to have your child evaluated and treated if necessary. If you know someone who is in crisis do not leave them alone, instead get them help, go to an emergency room or call 911 if it is necessary to keep them safe from themselves. If you are in need of help, the same applies and you can also call a free suicide hotline at 1-800-273-TALK (8225). Also, www.thebalancedmind.org . Their “Library” section has terrific information on pediatric bipolar disorder as well as an excellent checklist to help you monitor your child’s behavior.

Abnormal Psychology, Popular Psychology

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

by Torey C. Richards, LMHCLeave a Comment on Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

There is a growing hypothesis that there exist in a small subset of children, a form of rapidly forming obsessive-compulsive disorder (OCD) and/or tic disorder known as PANDAS.

PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. According to research, these children literally go from “normal” to “abnormal” in the matter of hours. Parents are usually able to pinpoint the exact time and day their child’s behavior changed in the forms of tics (erratic movements or vocalizations), emotional irritability, bed wetting and lose of previous learned motor skills. This is thought to follow exposure to the strep virus (i.e. a strep throat) and appears to be some type of autoimmune reaction.

PANDAS was first proposed during observations and clinical trials by the US National Institute of Health and was verified by further clinical trials, where children, after having been exposed to the streptococcal virus, developed rapid, sudden and dramatic OCD and tic disorder symptoms. There isn’t a 100% cause and effect between streptococcal and PANDAS, or even clear evidence that PANDAS is a separate disorder from Tourettes/OCD, so research is ongoing. Because of this, PANDAS is not yet, or may never be considered a complete disease on it’s on, and there is some discussion that it should be called PANS, an acronym for Pediatric acute-onset neuropsychiatric syndrome to further include not just the sudden onset of tics and OCD symptoms following exposure to a previous infection, but the sudden onset in children regardless of a previous infection or not.

What if I Think My Child Has PANDAS and is There a Cure?

Your family doctor or psychiatrist will be able to access and diagnosis whether your child has PANDAS or not. Treatment for PANDAS right now are the same as the treatment for Tourettes and OCD which include cognitive behavioral therapy and medications such as selective serotonin reuptake inhibitors (SSRIs). As research grows and the PANDAS hypothesis is either further confirmed or denied, other therapies and medication options will become available, but as of right now, there is no cure other than to try to reduce and control the disturbing and undesirable symptoms of PANDAS.

There seems to be a link between previous childhood exposure to infections such as strep throat, to the development of PANDAS, but there isn’t a 100% certain link and you shouldn’t worry too much that exposure to infection in childhood will lead to life long, neuropsychiatric problems. However, there seems to be growing evidence that in some children, this is the case and like with every child, if you notice sudden changes in your child, such as decrease in previous learned motor skills, increased irritability, tics (vocal and/or physical), difficulty sleeping, difficulty eating or any other unusual behaviors, it is very important to have your child seen by a doctor or specialist to not only rule out PANDAS, but also other diseases and pervasive developmental disorders such as Autism, Aspergers and childhood disintergrative disorder.

For more information on PANDAS visit http://intramural.nimh.nih.gov/pdn/web.htm